Division of Educational Psychology
Membership Application Form
Name:
Mailing address:
Contact number
Email:
PSI membership No.
Are you a Registered Psychologist with PSI?
Yes
No
Date of Registration:
Do you hold a Statement of Equivalence in Educational
Psychology?
Yes
Application for:
Full membership
Affiliate membership
No
(Please refer to the attached membership rules)
WORK EXPERIENCE IN PSYCHOLOGY
Please list the employment/work experience that you have obtained in the general area of
Educational Psychology in chronological order, starting with the first. Indicate your
current appointment.
Notes
Job title or
Job Title or
occupation
Occupation
Indicate with a
bracket or in some
other way any
appointments you
have held (or
hold)
concurrently.
Dates
Give month and
year. It will be
assumed you were
not working as a
psychologist
during any period
not accounted for
in your
employment
record.
Supervisor
Your Supervisor
should be a
Registered/Senior
Educational
Psychologist.
Please note :
work
experience in
private practice
must have been
supervised by a
Registered
Psychologist for
accreditation.
The Division may
request your
supervisor to
complete a short
form confirming
the amount of
supervision you
received
If the spaces
provided are
insufficient,
please photocopy
this page to
accommodate
additional
information and
attach
the
photocopied page
to
your
application.
Employer
and
address
Full-time
Part-time
Hours per
week
Weeks per
year
Date from
Date to
Supervisor’s
Name
QUALIFICATIONS IN PSYCHOLOGY
First Degree or
Diploma in
Psychology,
conferring Graduate
Membership of PSI
Postgraduate Professional
Qualification in Applied
Psychology e.g. MA in
Educational Psychology
Other relevant
Postgraduate
Qualification(s) in
Psychology
Degree
Obtained
Name of
University/Coll
ege/other
degree
awarding
authority
Type of Study
and
Assessment
Method
Start Date.
Completion
Date
Date Awarded.
Notes about the row headings:
Degree obtained: Please give the full title of your degree with your honours classification, for example, BA 2(1) Hons.
Types of study and assessment methods: Full time/part time/distance learning, State whether your postgraduate
qualification involved course work, empirical research, or some combination, and how it was assessed for example:
- Course work and examination
- 60% course and exam, 40% thesis
- Research and thesis
- Course work and continuous assessment
If you currently hold a teaching qualification please state what this qualification is (e.g.
B.Ed, H.Dip.Ed, NT):
_______________________________________________________________________
Comment briefly in this section on any teaching experience you may have obtained:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If necessary, briefly describe in this section any other work experience / training you
consider relevant to your application:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I, the undersigned, certify that the details I have provided above and/or have
enclosed with this Application Form, are accurate to the best of my knowledge.
Signed: _________________________________
Date: ___________________________________
For office use only:
Application evaluated and countersigned by:
(1)
PSI no.
(2)
PSI no.
Date: ___________________________
Membership rules
Membership of the Division is open only to graduate members of the Society.
There are two categories of membership of the Division. These are as follows:
Full Membership
(a) That they hold a postgraduate professional qualification in Educational
Psychology recognised by the Society
Or
(b) That they hold a Statement of Equivalence in Educational Psychology as
recognised by the Society or that they have been deemed eligible by the
Society to meet the criteria for a Statement of Equivalence in Educational
Psychology
Affiliate Membership
(a) That they are students of a postgraduate training course in Educational
Psychology
Or
(b) That they are, at the time of application, working in the area of Educational
Psychology as recognised by the Division.
Membership fees:
Full membership = €20 per year
Affiliate membership = €12 per year
Please do not include payment with your Application Form.
Please return to: Division of Educational Psychology, Psychological
Society of Ireland, 2nd Floor, Grantham House, Grantham Street, Dublin 2